Staged repair of borderline hypoplastic heart disease with early biventricular conversionCentral MessagePerspective
Objective: In select patients with borderline ventricular hypoplasia, we adopted a strategy of initial single-ventricle palliation followed by staged or direct biventricular conversion by 2 years of age. Methods: Between 2018 and 2023, 14 newborns with borderline hypoplastic heart disease deemed hig...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-04-01
|
| Series: | JTCVS Techniques |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250724000610 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849405572713021440 |
|---|---|
| author | Nicholas D. Andersen, MD Douglas M. Overbey, MD Neel K. Prabhu, MD Andrew W. McCrary, MD, MSc Jennifer I. Sherwin, MD Veerajalandhar Allareddy, MD Joseph W. Turek, MD, PhD |
| author_facet | Nicholas D. Andersen, MD Douglas M. Overbey, MD Neel K. Prabhu, MD Andrew W. McCrary, MD, MSc Jennifer I. Sherwin, MD Veerajalandhar Allareddy, MD Joseph W. Turek, MD, PhD |
| author_sort | Nicholas D. Andersen, MD |
| collection | DOAJ |
| description | Objective: In select patients with borderline ventricular hypoplasia, we adopted a strategy of initial single-ventricle palliation followed by staged or direct biventricular conversion by 2 years of age. Methods: Between 2018 and 2023, 14 newborns with borderline hypoplastic heart disease deemed high risk for primary biventricular repair underwent palliative procedures as a neonate/infant, followed by staged or direct biventricular conversion. Results: Of the 14 patients, 6 had borderline left ventricles and 8 had borderline right ventricles. Index neonatal operations were performed in 12 patients and included the Norwood operation (n = 5), pulmonary artery band (n = 3), ductal stent (n = 3), and hybrid Norwood (n = 1). Five patients underwent direct biventricular conversion, and the remaining 9 patients underwent staged ventricular recruitment operations at a mean age of 6 months (range, 3-11 months). Ventricular recruitment operations included atrial septation with or without ventricular rehabilitation, atrioventricular valve repair, or outflow tract operations. At a mean duration of 8 months (range, 4-10 months) after ventricular recruitment, there was a significant increase in chamber volume, aortic valve, and mitral valve size in patients with borderline left ventricles, and a normalization of the right ventricle:left ventricle end-diastolic volume ratio in patients with borderline right ventricles. To date, 13 of 14 patients have undergone successful biventricular conversion at a mean age of 16 months (range, 4-31 months). Conclusions: In select newborns with borderline hypoplastic heart disease, single-ventricle palliation followed by staged or direct biventricular conversion may increase infant survival while allowing for early attainment of a biventricular circulation. |
| format | Article |
| id | doaj-art-3487b08429e24f20a6953d41d8bcb8df |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-3487b08429e24f20a6953d41d8bcb8df2025-08-20T03:36:38ZengElsevierJTCVS Techniques2666-25072024-04-012415016310.1016/j.xjtc.2024.02.006Staged repair of borderline hypoplastic heart disease with early biventricular conversionCentral MessagePerspectiveNicholas D. Andersen, MD0Douglas M. Overbey, MD1Neel K. Prabhu, MD2Andrew W. McCrary, MD, MSc3Jennifer I. Sherwin, MD4Veerajalandhar Allareddy, MD5Joseph W. Turek, MD, PhD6Department of Cardiothoracic Surgery, University of Texas Southwestern and Children's Health, Dallas, Tex; Address for reprints: Nicholas D. Andersen, MD, Division of Pediatric Cardiothoracic Surgery, Children's Medical Center Dallas, 1935 Medical District Dr, Dallas, TX 75235.Department of Surgery, Duke Children's Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NCDepartment of Surgery, Duke Children's Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NCDepartment of Pediatrics, Duke Children's Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NCDepartment of Pediatrics, Duke Children's Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NCDepartment of Pediatrics, Duke Children's Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NCDepartment of Surgery, Duke Children's Pediatric & Congenital Heart Center, Duke Children's Hospital, Durham, NCObjective: In select patients with borderline ventricular hypoplasia, we adopted a strategy of initial single-ventricle palliation followed by staged or direct biventricular conversion by 2 years of age. Methods: Between 2018 and 2023, 14 newborns with borderline hypoplastic heart disease deemed high risk for primary biventricular repair underwent palliative procedures as a neonate/infant, followed by staged or direct biventricular conversion. Results: Of the 14 patients, 6 had borderline left ventricles and 8 had borderline right ventricles. Index neonatal operations were performed in 12 patients and included the Norwood operation (n = 5), pulmonary artery band (n = 3), ductal stent (n = 3), and hybrid Norwood (n = 1). Five patients underwent direct biventricular conversion, and the remaining 9 patients underwent staged ventricular recruitment operations at a mean age of 6 months (range, 3-11 months). Ventricular recruitment operations included atrial septation with or without ventricular rehabilitation, atrioventricular valve repair, or outflow tract operations. At a mean duration of 8 months (range, 4-10 months) after ventricular recruitment, there was a significant increase in chamber volume, aortic valve, and mitral valve size in patients with borderline left ventricles, and a normalization of the right ventricle:left ventricle end-diastolic volume ratio in patients with borderline right ventricles. To date, 13 of 14 patients have undergone successful biventricular conversion at a mean age of 16 months (range, 4-31 months). Conclusions: In select newborns with borderline hypoplastic heart disease, single-ventricle palliation followed by staged or direct biventricular conversion may increase infant survival while allowing for early attainment of a biventricular circulation.http://www.sciencedirect.com/science/article/pii/S2666250724000610atrioventricular septal defectbiventricular conversionborderline ventriclehypoplastic left heart syndromeventricular recruitment |
| spellingShingle | Nicholas D. Andersen, MD Douglas M. Overbey, MD Neel K. Prabhu, MD Andrew W. McCrary, MD, MSc Jennifer I. Sherwin, MD Veerajalandhar Allareddy, MD Joseph W. Turek, MD, PhD Staged repair of borderline hypoplastic heart disease with early biventricular conversionCentral MessagePerspective JTCVS Techniques atrioventricular septal defect biventricular conversion borderline ventricle hypoplastic left heart syndrome ventricular recruitment |
| title | Staged repair of borderline hypoplastic heart disease with early biventricular conversionCentral MessagePerspective |
| title_full | Staged repair of borderline hypoplastic heart disease with early biventricular conversionCentral MessagePerspective |
| title_fullStr | Staged repair of borderline hypoplastic heart disease with early biventricular conversionCentral MessagePerspective |
| title_full_unstemmed | Staged repair of borderline hypoplastic heart disease with early biventricular conversionCentral MessagePerspective |
| title_short | Staged repair of borderline hypoplastic heart disease with early biventricular conversionCentral MessagePerspective |
| title_sort | staged repair of borderline hypoplastic heart disease with early biventricular conversioncentral messageperspective |
| topic | atrioventricular septal defect biventricular conversion borderline ventricle hypoplastic left heart syndrome ventricular recruitment |
| url | http://www.sciencedirect.com/science/article/pii/S2666250724000610 |
| work_keys_str_mv | AT nicholasdandersenmd stagedrepairofborderlinehypoplasticheartdiseasewithearlybiventricularconversioncentralmessageperspective AT douglasmoverbeymd stagedrepairofborderlinehypoplasticheartdiseasewithearlybiventricularconversioncentralmessageperspective AT neelkprabhumd stagedrepairofborderlinehypoplasticheartdiseasewithearlybiventricularconversioncentralmessageperspective AT andrewwmccrarymdmsc stagedrepairofborderlinehypoplasticheartdiseasewithearlybiventricularconversioncentralmessageperspective AT jenniferisherwinmd stagedrepairofborderlinehypoplasticheartdiseasewithearlybiventricularconversioncentralmessageperspective AT veerajalandharallareddymd stagedrepairofborderlinehypoplasticheartdiseasewithearlybiventricularconversioncentralmessageperspective AT josephwturekmdphd stagedrepairofborderlinehypoplasticheartdiseasewithearlybiventricularconversioncentralmessageperspective |